Second-Line Aflibercept Reduces New-Onset Visual Impairments in Wet AMD

A study assessed the association between the rate of intravitreal anti-vascular endothelial growth factor therapy (VEGF) injections and second-line aflibercept use and visual impairment in patients with wet age‐related macular degeneration (AMD).

Five university hospitals and 14 central hospital districts provided data spanning 2015 through 2017 pertaining to anti-VEGF treatment, bevacizumab and aflibercept proportions, and new visual impairments attributed to wet AMD. Data covered 232,568 injections and 1,172 visual impairments.

During the study period, the annual number of anti-VEGF injections increased from 60,412 in 2015 to 93,589 in 2017—a 24% increased annual change. Annual aflibercept injections increased from 8,299 to 20,833—a 58.8% increased annual change. Between hospital districts, the three-year average for total anti-VEGF injections ranged from 9.6 to 21.1 (median, 13.3) per 1,000 citizens; aflibercept injections ranged from 0.8 to 4.0 (median, 1.9). Per the wet AMD primary protocol, the number of total anti-VEGF injections increased from 10.9 in 2015 to 15.2 in 2017 per 1,000 citizens with the pro re nata (PRN) protocol and from 11.3 to 18.9 with the treat‐and‐extend regimen (TER). In the hospital districts, an inverse correlation was observed between the three-year average of aflibercept injections as a second-line treatment and new-onset visual impairments (P=0.027). No significant differences were observed in the number of visual impairments between the PRN (1.23) and TER (1.14) protocols in the hospital districts per 1,000 citizens aged ≥64 years (P=0.713).

“These results emphasize that the use of aflibercept injections as a second‐line treatment may decrease new-onset visual impairments,” concluded the authors.